Prospective randomised study using focus harmonic scalpel versus conventional hemostasis for vessel ligation in open thyroid surgery

Background: The objective was to compare operative factors, postoperative and surgical complications of open thyroidectomy by using FOCUS harmonic scalpel (HS) versus conventional hemostasis.Methods: A prospective randomised study in which 34 patients with benign/malignant thyroid disease patients underwent open thyroidectomy, patients were randomised into two groups, Group -1(HS) - included 19 patients which FOCUS Harmonic scalpel was used exclusively, Group -2(CH) included 15 patients in which conventional hemostasis was used exclusively. We recorded operative time, postoperative blood loss and drain output, postoperative complications and duration of hospital stay, patients were watched for 48-72 hours following surgery. The results were analysed by using student’s t-test.Results: Mean operative time for hemithyroidectomy was 53.40±9.07 minutes in HS group versus 85.25±17.03 minutes in CH group (p-value -0.004) mean operative in patients who underwent near total thyroidectomy is 67.21±10.36 in HS group v/s 109.60±29.35ml in CH group (p-value 0.001), postoperative drain output in patients who underwent hemithyroidectomy in HS group is 16.00±15.16 v/s 36.25±4.78 ml in CH group (p-value 0.008), postoperative drain output in patients who underwent near total thyroidectomy in HS group is 28.21±16.36ml v/s 45.50±8.95ml in CH group(p-value 0.006),length of hospital stay is 3.28±1.06 days in HS group v/s 4.20±1.39days in CH group,(p-value-0.083), complications like temporary hypocalcemia was present in 1 patient in HS group v/s 3 patients in CH group ,temporary RLN palsy was present in 2 patients in each group, there were no cases of permanent RLN palsy in either group, neither were the cases of permanent hypoparathyroidism in either group.Conclusions: FOCUS Harmonic scalpel will reduce operative time, reduces the incidence of symptomatic hypocalcemia but not temporary hypocalcemia,reduces postoperative drain output, reduces the duration of hospital stay, and shows no significance on incidence of temporary/permanent RLN palsy. FOCUS harmonic scalpel supposed to be more reliable and safe instrument that can be used instead of conventional hemostasis techniques in open thyroidectomy.

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Efficacy and Budget Impact of the Focus Harmonic Scalpel Compared to the ACS-14C Device in Total Thyroidectomy Due to Multinodular Goitre. A Prospective Randomised Study

Cirugía Española (English Edition) ◽

10.1016/j.cireng.2014.01.026 ◽

2013 ◽

Vol 91 (10) ◽

pp. 664-671

Author(s):

Pablo Moreno ◽

José Manuel Francos ◽

Arantxa García-Barrasa ◽

Enrique Fernández-Alsina ◽

Eugenia de Lama ◽

...

Keyword(s):

Total Thyroidectomy ◽

Budget Impact ◽

Harmonic Scalpel ◽

Multinodular Goitre ◽

Randomised Study ◽

Prospective Randomised Study

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Harmonic scalpel versus titanium clips and l-hook in the ligation of cystic duct and artery and gall bladder dissection in laparoscopic cholecystectomy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175075 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5145

Author(s):

Anand Vijayvargiya ◽

S. K. Jain ◽

Varsha Soni

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Hospital Stay ◽

Cystic Duct ◽

Harmonic Scalpel ◽

P Value ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Conversion To Open Cholecystectomy ◽

Duration Of Surgery

Background: Laparoscopic cholecystectomy is a gold standard for gall bladder stone surgery. The Aim and objective of study was to compare the total duration of surgery, intraoperative complication like bile leak from cystic duct stump, spillage of bile from gallbladder and post op pain and abdomen distension and jaundice.Methods: Study was carried out in dept. of gen Surgery, Govt medical college Kota in yr. 2015-16 in a total of 50 patients with cholelithiasis with cholecystitis. Patient were equally divided randomly into two groups (a) Harmonic scalpel group and (b) Titanium Clip and L hook group. All patients with medical comorbidities, Concomitant CBD calculi, cirrhosis and portal HT were excluded from study. Intraoperatively adhesions, bile spillage from GB and cystic duct stump noted Postoperatively complain like pain abdomen, Jaundice, and fever were noted. Duration of hospital stay was observed. All results were statistically analyzed using Chi square and ANOVA test.Results: Both groups were comparable on the basis of age and sex distribution, as no statistically difference was noted (P value 0.867 and 0.999 respectively). Intraoperative findings were adhesions 5 in clip group and 7 in harmonic group. Spillage from gall bladder was 2 in Clip group and 3 in harmonic group. Mean duration of surgery was 65.20 min in clip group and 63.68 in harmonic group with no statistically significant difference in both the group (P Value 0.727). Average duration of hospital stay was similar in both the groups with a mean of 2.6 days. Postoperative complication was fever, abdomen pain and distension were 3,1,1 were respectively in the clip group and 3,2,2 respectively in harmonic group with the P value of 0.999 which was statistically insignificant. No CBD injury was noted in any case. Conversion to open cholecystectomy was not done in any case. On 1week and 1 month follow up 2 cases in clip group and 1 in HS group had collection in gall bladder fossa and none at I month.Conclusions: Harmonic scalpel offers an effective, alternative and safe method to cystic duct division and Gallbladder dissection from liver bed.

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A Single Surgeon’s Experience of Total Extra Peritoneal Repair Vs Transabdominal Preperitoneal Repair- A Prospective Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/47056.14406 ◽

2021 ◽

Author(s):

Tharun Ganapathy Chitrambalam ◽

Koshy Mathew Panicker ◽

Jeyakumar Sundaraj ◽

Sidhu Rajasekhar ◽

Pradeep Joshua Christopher

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hospital Stay ◽

Pain Score ◽

Operative Time ◽

P Value ◽

Tep Repair ◽

Duration Of Hospital Stay ◽

Tapp Repair ◽

The Mean

Introduction: Hernia surgery has evolved over a period of 2500 years from the Bassini-Shouldice era to conventional Lichenstein’s meshplasty to the laparoscopic era. Since, inception of the laparoscopic approach 25 years ago, there were several advancements in the techniques of inguinal hernia repairs. The two most commonly practiced laparoscopic approaches are the Total Extra Peritoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair. Aim: To compare the outcomes for TEP and TAPP approaches in laparoscopic inguinal hernia surgery in terms of operative time consumed, postoperative pain, duration of hospital stay, complications and recurrence rate when performed by a single surgeon. Materials and Methods: A prospective interventional cohort study was carried out among 70 patients with uncomplicated inguinal hernia. Patients were divided equally into two groups of 35 patients and underwent TAPP and TEP repairs depending on group randomisation. All surgeries were performed by the same surgeon. Factors including operative time, postoperative pain, duration of hospital stay, complications and recurrence were documented and compared for both the groups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21. Unpaired t-test was used to compare the mean between the two groups. The p-value of <0.05 was considered to be statistically significant. Results: The mean operative time measured in minutes for TEP repair was 31.03 minutes and TAPP repair was 42.26 showing a difference of 11.23 minutes which was statistically significant (p-0.001). The mean Standard Deviation (SD) pain score at 24 hours for TEP repair was 2.43 (1.195) and TAPP repair was 3.43 (0.917). The mean (SD) pain score at 48 hours for TEP repair was 1.31 (1.051) and TAPP repair was 2.20 (0.901). The mean (SD) pain score at one week for TEP repair was 0.37 (0.690) and TAPP repair was 0.91 (0.781). The mean (SD) duration of hospital stay in TEP repair was 2.60 days (0.553) when compared to 3.49 days (0.658) in TAPP repair. All the results were statistically significant with a p-value of 0.001. Conclusion: TEP repair had superior outcomes in terms of reduction in operative time, less postoperative pain and shorter hospital stay than TAPP repair.

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Comparative study between vaginal and abdominal hysterectomy in non-descent cases

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20160715 ◽

2016 ◽

Vol 2 (3) ◽

pp. 48

Author(s):

Rohidas P. Chavvan ◽

Garima Arora ◽

Sandhya Pajai

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Operating Time ◽

Hospital Charges ◽

P Value ◽

Operative Morbidity ◽

Duration Of Hospital Stay ◽

The World ◽

Operative Complications ◽

Post Operative Complications

Background: Hysterectomy is the major gynaecological surgery performed by gynaecologist all over the world. Various approaches have been tried by gynaecologist all over the world including abdominal, vaginal, laparoscopic, notes and robotic hysterectomy. Vaginal approach greatly reduces complications, decreases hospital stay, lowers hospital charges, post-operative discomfort and cosmetically better compared to abdominal and laparoscopic approaches. Vaginal hysterectomy in large sized uterus can be facilitated by bisection, myomectomy, debulking, coring and clamp less approach. The aim and objective of the study was to compare outcome of NDVH with outcome of TAH in terms of post-operative morbidity and duration of hospital stay.Methods:A total of 100 cases were selected with enlarged uterus of which 50 underwent NDVH and rest 50 underwent TAH. All patients were evaluated for operative time, intra-operative and post-operative complications and duration of hospital stay. Data were recorded and processed and standard statistical software were used.Results: Patients undergoing NDVH had an average operating time of 48.68 mins whereas for those undergoing TAH was 92.52 mins (‘p’- value <0.001). Intra-operative complications were noted in 2% of patients undergoing NDVH whereas in 20% of patients undergoing TAH (‘p’- value 0.016). Post-operative complications were noted in 34% of patients undergoing NDVH v/s 70% in TAH (‘p’- value <0.001). Patients undergoing NDVH had a mean hospital stay of 5.96 days whereas 9.10 days in those undergoing TAH (‘p’- value <0.001).Conclusions:NDVH is associated with decreased operative time, post-operative morbidity, early ambulation and early discharge from hospital compared to TAH.

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Radiofrequency dissection versus ‘knot tying’ in conventional total thyroidectomy

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001789 ◽

2014 ◽

Vol 128 (9) ◽

pp. 818-823 ◽

Cited By ~ 1

Author(s):

M H Ozkul ◽

R M Açikalin ◽

H H Balikci ◽

O Bayram ◽

AA Bayram

Keyword(s):

Total Thyroidectomy ◽

Operative Time ◽

Surgical Instruments ◽

Knot Tying ◽

Safe Alternative ◽

Randomised Study ◽

Operative Drainage ◽

Knot Tying Technique ◽

Prospective Randomised Study ◽

Dissection Method

AbstractObjective:To evaluate the safety and effectiveness of radiofrequency dissection in conventional ‘open’ total thyroidectomy.Methods:Thirty-nine patients scheduled for conventional total thyroidectomy were included in a prospective randomised study. Patients were randomly assigned to one of two groups: a radiofrequency dissection method was used in one group, and a knot tying technique was used in the other.Results:Significantly fewer surgical instruments and materials were required for the radiofrequency dissection group than the knot tying group (p < 0.01). There were no significant differences between the two groups in mean operative time, blood loss, post-operative drainage and pain, recurrent palsy, and hypocalcaemia (p > 0.05).Conclusion:Radiofrequency dissection is a safe alternative to the knot tying technique, and enables a significant reduction in the number of surgical instruments required for the operation.

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Focus Harmonic Scalpel Compared to Conventional Haemostasis in Open Total Thyroidectomy: A Prospective Randomized Trial

International Journal of Otolaryngology ◽

10.1155/2011/357195 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 29

Author(s):

Emanuele Ferri ◽

Enrico Armato ◽

Giacomo Spinato ◽

Roberto Spinato

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Randomized Trial ◽

Total Thyroidectomy ◽

Operative Time ◽

Harmonic Scalpel ◽

Thyroid Volume ◽

Prospective Randomized Trial ◽

Drainage Volume ◽

Significant Difference

The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes and surgical complications of open total thyroidectomy when using the Harmonic Scalpel (HS) versus Conventional Haemostasis (CH).Methods. 100 consecutive patients underwent open total thyroidectomy were randomized into two groups: group CH (Conventional Haemostasis) and group HS (Harmonic Scalpel). We recorded the following: age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications, and hospital stay. The results were analyzed using the Student’sttest and test.Results. No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was significantly shorter in the HS group. The total drainage fluid volume was lower in HS group. Two (4%) transient recurrent laryngeal nerve palsies were observed in CH group and no one (0%) in the HS group. Postoperative transient hypocalcemia occurred more frequently in the CH group. HS group experienced significantly less postoperative pain at 24 and 48 hours.Conclusions. In patients undergoing thyroidectomy, HS is a reliable and safe tool. Comparing with CH techniques, its use reduces operative times, postoperative pain, drainage volume and transient hypocalcemia.

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Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i30b31641 ◽

2021 ◽

pp. 65-69

Author(s):

Shiraz Shaikh ◽

Champa Sushel ◽

Ahsan Ali Laghari ◽

Qamber Ali Laghari ◽

Zameer Hussain Laghari ◽

...

Keyword(s):

Hospital Stay ◽

Total Thyroidectomy ◽

Calcium Level ◽

Operative Time ◽

Nodular Goiter ◽

Cross Sectional Study ◽

Cross Sectional ◽

Post Operative Pain ◽

Significant Difference ◽

One Year

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage. Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique. Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain & post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20. Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-<0.001). Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.

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Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-1303 ◽

2021 ◽

Author(s):

Muhammad Ahmad ◽

Syed Tatheer Abbas ◽

Amna Javaid ◽

Naveed Arshad ◽

Falak Shair

Keyword(s):

Wound Healing ◽

Operative Time ◽

Harmonic Scalpel ◽

Controlled Trial ◽

P Value ◽

Randomized Controlled ◽

Group A ◽

The Mean ◽

Complete Wound Healing ◽

Group B

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...

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Laparoscopic versus open surgical approach of cholecystectomy in patients with symptomatic cholelithiasis: a systematic review of comparative trials

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20210545 ◽

2021 ◽

Vol 7 (3) ◽

pp. 167

Author(s):

Omer A. Marzoug

Keyword(s):

Systematic Review ◽

Hospital Stay ◽

Operative Time ◽

Open Cholecystectomy ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

P Value ◽

Symptomatic Cholelithiasis ◽

Pain Duration ◽

Comparative Trials

Symptomatic cholelithiasis (gallstone disease) is the most common biliary pathology that affects women predominantly around the world. Earlier open cholecystectomy was the gold standard of treatment of this disease before introduction of laparoscopic cholecystectomy. The aim of this study is to systematically review the most recent published data that compared laparoscopic with open cholecystectomy in symptomatic cholelithiasis in terms of operative and post-operative morbidity, mortality, operative time, length of hospital stay, and conversion rates. The Medline, Cochrane library, Embase, and PubMed databases were vigorously searched for trials that compared laparoscopic with open cholectstectomy in patients with symptomatic cholelithiasis, a systematic review of these comparative trials was performed. No mortality was detected in both groups; the conversion rate was 6.75%. The laparoscopic approach associated with significantly shorter hospital stay (2.31 versus 4.42 days, p value>0.001), lower post-operative pain duration (30.5 versus 66.9 hours, p value>0.001) and lower rate of post-operative wound infection (2.8% versus 10.5%, p value>0.001). Regarding operative time it was significantly longer in laparoscopic approach (77.3 versus 67.1 min, p value>0.001), there were no significant differences in the rates of bile duct injury (0.84% versus 0.25%, p value=0.08) and intra-operative bleeding (4.2% versus 3.5%, p value=0.81) between the two procedures. Post-operative wound infection and pain duration in addition to length of hospital stay in patients with symptomatic cholelithiasis were reduced with laparoscopic cholecystectomy. However, the laparoscopic approach associated with longer duration of surgery. No significant differences between the two procedures in the rates of bile duct injury and intra-operative bleeding.

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Comparison of laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.10.4327 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2050-2055

Author(s):

Muhammad Asif ◽

Muhammad Faheem Anwer ◽

Muhammad Hasan Anwaar ◽

Shahbaz Ahmad ◽

Muhammad Kamran ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Loss ◽

Operative Time ◽

Harmonic Scalpel ◽

Conventional Group ◽

P Value ◽

Conventional Laparoscopic Cholecystectomy ◽

Conventional Laparoscopic ◽

Symptomatic Gallstones ◽

Group B

Objectives: To compare the laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss. Study Design: Randomized Control trial. Setting: Department of Surgical at Allied Hospital Faisalabad. Period: 6 months Oct 2017 to Mar 2018. Material & Methods: Eighty (80) patients (forty in one group) divided randomly into A (harmonic scalpel group) and B (conventional) group, done under general anesthesia. Total time of operation and blood loss during procedure was noted. Results: Our study showed that mean operative time in Harmonic group (A) was 38.07+5.28 minutes and in Conventional group (B) 63.75+7.62 minutes, (p-value = 0.0001), blood loss in Harmonic group (A) 32.93+8.86ml and 55.53+8.96ml in Conventional group (B), (p-value = 0.0001). Conclusion: It is concluded that the laparoscopic cholecystectomy using harmonic scalpel is significantly better when compared with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss.

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